Application licensing for a centralized system of medical devices

ABSTRACT

Centralized systems execute one or more applications for monitoring and operating a plurality of network enabled medical devices. An indication to start a selected application at the centralized system or at a network enabled medical device is received at the centralized system/network enabled medical device. The selected application may require a license to operate and, at the time the indication is received, may have a first license available. Instead of using the first license, the centralized system/network enabled medical device may determine to inherit at least a portion of a second license to operate the selected application. The centralized system/network enabled medical device may inherit at least the portion of the second license to form an inherited license, where the inherited license enables features of the selected application. Using the inherited license, the selected application is started with the enabled features. Related apparatus, systems, techniques and articles are also described.

TECHNICAL FIELD

The subject matter described herein relates to licensing of applicationsin a centralized system of medical devices.

BACKGROUND

To improve cost efficiency and patient care, hospitals and other carefacilities are increasingly using medical devices such as vital signsmonitors and infusion pumps. Increasingly, these devices are controlledby electronics including one or more processors. These devices aretypically programmable and may be controlled by a centralized system.Both the medical devices and the centralized system often containmultiple applications. A manufacturer of those applications may want tocontrol access to the applications. For example, the manufacturer maylimit access to customers that have paid for use of the applications.

SUMMARY

A centralized system executes one or more applications for monitoringand operating a plurality of network enabled medical devices. Anindication to start a selected application at the centralized system orat a network enabled medical device may be received at the centralizedsystem/network enabled medical device. The selected application mayrequire a license to operate and, at the time the indication isreceived, may have a first license available. Instead of using the firstlicense, the centralized system/network enabled medical device maydetermine to inherit at least a portion of a second license to operatethe selected application. The centralized system/network enabled medicaldevice may inherit at least the portion of the second license to form aninherited license, where the inherited license enables features of theselected application. Using the inherited license, the selectedapplication is started with the enabled features.

In some implementations, the selected application may be a command andstatus application for an infusion pump and/or the selected applicationmay include executable instructions for the centralized system/networkenabled medical device. A medical device may be an infusion pump, avital signs monitor, a ventilator, or other network enabled medicaldevice.

Determining to inherit at least a portion of a second license mayinclude one or more of the following: selecting to use the portion ofthe second license rather than the first license, determining that thefirst license is not available or the first license is not valid,reading the portion of the second license from the centralized systemand extracting license information applicable to the selectedapplication and determining that the portion of the second licensepermits use of the selected application.

In some implementations, an indication to start an application thatrequires a decrypted license to operate at a centralized system may bereceived at the centralized system. The centralized system may executeapplications for monitoring and operating a plurality of network enabledmedical devices. Upon decrypting the license to produce a decryptedlicense, the centralized system may determine that communication with alicense server is required. The centralized system may poll the licenseserver with data characterizing the decrypted license to receive a newlicense, and update the decrypted license based on the new license. Insome implementations one or more of the following features may beincluded: the application may be a command and status application for aninfusion pump, the application may include executable instructions forthe centralized system, the decrypting may include decryption with anadvanced encryption standard, the plurality of network enabled medicaldevices may include one or more of infusion pumps, vital signs monitors,and ventilators

The determining from the decrypted license that communication with alicense server is required may include: searching the decrypted licensefor a limit value to a configuration parameter of the centralizedsystem; searching a configuration of the centralized system for anactual value of the configuration parameter; and determining from thelimit value and the actual value whether communication with the licenseserver must be initiated, and/or determining from logic included in thedecrypted license that communication with the license server isrequired.

Computer program products are also described that comprisenon-transitory computer-readable media storing instructions, which whenexecuted by one or more data processors of one or more computingsystems, causes at least one data processor to perform operationsherein. Similarly, computer systems are also described that may includeone or more data processors and a memory coupled to the one or more dataprocessors. The memory may temporarily or permanently store instructionsthat cause at least one processor to perform one or more of theoperations described herein. In addition, methods can be implemented byone or more data processors either within a single computing system ordistributed among two or more computing systems. Such computing systemscan be connected and can exchange data and/or commands or otherinstructions or the like via one or more connections, including but notlimited to a connection over a network (e.g. the Internet, a wide areanetwork, a local area network, a wireless network, a wired network, orthe like), via a direct connection between one or more of the multiplecomputing systems, etc.

The current subject matter provides many advantages. For example, thecurrent subject matter enables licensing of applications and features ofapplications made available at medical devices and centralized systemsof medical devices which in turn provides better coordination betweenapplication manufacturers and care providers within a healthcarecomputing environment.

The details of one or more variations of the subject matter describedherein are set forth in the accompanying drawings and the descriptionbelow. Other features and advantages of the subject matter describedherein will be apparent from the description and drawings, and from theclaims.

DESCRIPTION OF DRAWINGS

FIG. 1 is a system diagram illustrating a computing landscape within ahealthcare environment;

FIG. 2 is a system diagram illustrating a centralized system and medicaldevices connected through a network to a license server;

FIG. 3 is a process diagram illustrating enabling features of anapplication using a license;

FIG. 4 is a process diagram illustrating inheriting a license at aselected application from another license at another application; and

FIG. 5 is a process diagram illustrating a license server updating alicense.

Like reference symbols in the various drawings indicate like elements.

DETAILED DESCRIPTION

FIG. 1 is a system diagram illustrating a computing landscape 100 withina healthcare environment such as a hospital. Various devices andsystems, both local to the healthcare environment and remote from thehealthcare environment, can interact via at least one computing network105. This computing network 105 can provide any form or medium ofdigital communication connectivity (e.g., wired connection, opticalconnection, wireless connection, and so forth) amongst the variousdevices and systems. Examples of communication networks include a localarea network (“LAN”), a wide area network (“WAN”), and the Internet. Insome cases, one or more of the various devices and systems can interactdirectly via peer-to-peer coupling (for example, via a hardwiredconnection or via a wireless protocol such as Bluetooth or WiFi). Inaddition, in some variations, one or more of the devices and systemscommunicate via a cellular data network.

In particular, aspects of the computing landscape 100 can be implementedin a computing system that includes a back-end component (e.g., as adata server 110), or that includes a middleware component (e.g., anapplication server 115), or that includes a front-end component (e.g., aclient computer 120 having a graphical user interface or a Web browserthrough which a user may interact with an implementation of the subjectmatter described herein), or any combination of such back-end,middleware, or front-end components. A client 120 and server 110, 115are generally remote from each other and typically interact through thecommunications network 105. The relationship of the clients 120 andservers 110, 115 arises by virtue of computer programs running on therespective computers and may have a client-server relationship to eachother. Clients 120 can be any of a variety of computing platforms thatinclude local applications for providing various functionality withinthe healthcare environment. Example clients 120 include, but are notlimited to, desktop computers, laptop computers, tablets, and othercomputing devices that may have touch-screen interfaces. The localapplications can be self-contained in that they do not require networkconnectivity and/or they can interact with one or more of the servers110, 115 (e.g., via a web browser).

A variety of applications can be executed on the various devices andsystems within the computing landscape such as electronic health recordapplications, medical device monitoring, operation, and maintenanceapplications, scheduling applications, billing applications, and thelike.

The network 105 can be coupled to one or more data storage systems 125.The data storage systems 125 can include databases providing physicaldata storage within the healthcare environment or within a dedicatedfacility. In addition, or in the alternative, the data storage systems125 can include cloud-based systems providing remote storage of data in,for example, a multi-tenant computing environment. The data storagesystems 125 can also comprise non-transitory computer readable media.

Mobile communications devices (MCDs) 130 can also form part of thecomputing landscape 100. The MCDs 130 can communicate directly via thenetwork 105 and/or they can communicate with the network 105 via anintermediate network such as a cellular data network or other wired orwireless network. Various types of communication protocols can be usedby the MCDs 130 including, for example, messaging protocols such as SMSand MMS.

Various types of medical devices 140 can be used as part of thecomputing landscape 100. These medical devices 140 can comprise, unlessotherwise specified, any type of device or system with a communicationsinterface that characterizes one or more physiological measurements of apatient and/or that characterizes treatment of a patient. In some cases,the medical devices 140 communicate via peer to peer wired or wirelesscommunications with another medical device 140 (as opposed tocommunicating with the network 105). For example, a medical device 140can comprise a bedside vital signs monitor with wired and wirelessnetworking capability connected to other medical devices 140, namely awireless pulse oximeter and to a wired blood pressure monitor. One ormore operational parameters of the medical devices 140 can be locallycontrolled by a clinician, controlled via the network 105 by aclinician, and/or medical devices 140 can be controlled via network 105by one or more of a server 115, client 120, data storage systems 125,MCD 130, and/or another medical device 140.

The computing landscape 100 can provide various types of functionalityas may be required within a healthcare environment such as a hospital.For example, a pharmacy can initiate a prescription via one of theclient computers 120. This prescription can be stored in the datastorage systems 125 and/or pushed out to other clients 120, an MCD 130,and/or one or more of the medical devices 140. In addition, the medicaldevices 140 can provide data characterizing one or more physiologicalmeasurements of a patient and/or treatment of a patient (e.g., medicaldevice 140 can be an infusion management system, etc.). The datagenerated by the medical devices 140 can be communicated to othermedical devices 140, the servers 110, 115, the clients 120, the MCDs130, and/or stored in the data storage systems 125.

Medical devices 140 can include any combination of devices such asinfusion pumps (e.g., peristaltic pumps, large volume infusion pumps,syringe pumps, patient-controlled analgesia systems, etc.), ventilators,vital signs monitors, and other network enabled medical devices.Commercially available products include ALARIS SYSTEMS MANAGER, ALARISMEDLEY INFUSION PUMP, and ALARIS INFUSION VIEWER FOR PHARMACY LOGISTICSor similar products from Care Fusion Corporation, San Diego Calif. Manyof these products share data and customize a view of the data based onthe intended user. Medical devices may both provide patient care anddisplay pertinent information.

In some implementations consistent with FIG. 1, the computing landscape100 includes a centralized system, medical devices 140, network 105, andcellular network 135. The centralized system includes one or more ofclients 120, backend server(s) 110, application server(s) 115, datastorage systems 125, and MCD 130. Computing devices 110, 115, 120, 125,and 130 may connect to the network 105 through any wired or wirelessaccess network including cellular data network 135 or other network.Some medical devices 140 can connect directly to network 105, and somemedical devices 140 can connect to other medical devices in order toaccess network 105.

FIG. 2 is a system diagram 200 illustrating a centralized system ofmedical devices connected through a network to a license server. Medicaldevices 140 can be connected through connections 205 either directly tocentralized system 210, through network 105 to centralized system 210,or through another medical device to centralized system 210. Licenseserver 220 is also connected to centralized system 210 and medicaldevices 140 through connections 205 and network 105. License server 220can provide application licensing information to applications beingexecuted on centralized system 210 and/or medical devices 140. Thelicensing information can determine what applications are made availableand the features made available from those applications at centralizedsystem 210 and medical devices 140.

A centralized system such as centralized system 210 may reside on one ormore desktop computing devices and/or portable computing devices.Desktop computing devices include desktop computers with one or moreprocessors, servers, collections of computing devices, distributedcomputing devices and the like. Portable computing devices includelaptop computers, notebook computers, netbook computers, tabletcomputers, personal digital assistants (PDAs), smartphones, and otherssuch as custom designed computing devices.

Network 105 provides for communication through connections 205 betweencomputing devices such as centralized system 210 and license server 220,and communication through connections 205 between medical devices 140and centralized system 210. Centralized system 210 can also have aconnection to the internet. A user at a user interface, can access thecentralized system through a network connection 205. Each connection 205can be a wired or wireless connection, a serial connection, parallelconnection or any other type of communication connection. Connections205 can also include gateways or routers to provide access through theinternet.

A centralized system such as centralized system 210 can connect tobetween one and thousands of medical devices. In the example of FIG. 2,centralized system 210 connects to medical devices 140 and licenseserver 220 through network 105. Medical devices 140 can connect tocentralized system 210 through a switch or router not shown in FIG. 2.The connections 205 between medical devices 140 and the centralizedsystem 210 can be wired or wireless connections, or any combination ofwired and wireless connections.

Centralized system 210 can provide commands to medical devices 140. Thecommands can be individually addressed to one of the connected medicaldevices, or the commands can be broadcast to multiple medical devices140. Status data, maintenance data, usage data, and other data can bereceived at the centralized system 210 from any attached medical device140. Centralized system 210 can maintain a list of medical devices 140connected to it. The list of medical devices connected to thecentralized system 210 is sometimes referred to as a registry.

Applications that are executable at centralized system 210 can be storedat centralized system 210 and/or data storage 125. An application may bepart of a family of applications. A family of applications may includemultiple applications related to a particular product. Some applicationsmay be designed to require a license to operate. The license candetermine which applications and features are available at centralizedsystem 210. If the license permits use of an application, the licensemay further determine which features of the application are to beprovided. For example, the license may allow use of an application andenable some features of the application but the license may prevent useof other features. In order to make the other features or functionsavailable, the customer/licensee may be required to pay an additionalfee, and receive a new license that enables the other features.

The executable files for a complete family of applications can be storedat the centralized system 210 or data storage system 125. A license maypermit the use of all the applications in the family of applications, orthe license may permit the use of a subset of the family ofapplications. Without the license, the application cannot be operated.For example, a customer/licensee may have purchased a license for one ofthe applications in the family of applications. Despite thecustomer/licensee having a license for just one of the applications, theexecutable files for the entire family of applications may be stored atthe centralized system 210. In addition to the executable files alreadystored at the centralized system 210, the addition of a license may beall that is needed to operate that application.

If the customer/licensee wishes to enable additional features ofexisting applications and/or enable applications not previouslylicensed, the customer/licensee may gain access by paying any associatedfees to the manufacturer and receiving a new license. With the newlicense, the additional features of existing applications and/or newapplications are made available.

The license can be stored at centralized system 210 or at data storage125. When an application is started, the license is read to determine ifthe license permits operation of the application. The licensed featuresof the application are determined by the license. In someimplementations, the license can be stored at an application server 115or backend server 110, or may be provided by license server 220 throughconnections 205, network 105, and the internet each time an applicationis started.

Applications that are executable at medical devices 140 can be stored atthe medical devices 140, or at centralized system 210 and/or datastorage 125. Applications executable at the medical devices 140 mayrequire a license to operate. The license can determine whichapplications are available at medical devices 140. If the licensepermits use of an application, the license may further determine whichfeatures of the application are enabled. For example, the license mayallow use of an application and enable some features of the applicationbut the license may prevent use of other features. In order to make theother features available, the customer/licensee may be required to payan additional fee, and receive a new license that enables the otherfeatures.

The license for an application available at a particular medical devicecan be stored at that medical device. When an application is started,the license is read and the available features of the availableapplications are determined based on the license. In someimplementations, the license can be stored at centralized system 210,data storage 125, or may be provided by license server 220 throughconnections 205, network 105, and the internet, each time an applicationis started.

A license can be a file or a unique text string generated by licenseserver 220. The file may be in the form of a text file, binary file, orother file. For example, the license can be a text file stored atcentralized system 210 that enables a particular subset of features ofan infusion viewer application executable at the centralized system 210.In another example, the license for an application executable at medicaldevice 140 can be a binary file stored at the medical device 140. Thelicense can contain logic that interacts with centralized system 210and/or medical devices 140. For example, the license may limit a numberof medical devices to 3000 that are permitted to be connected to thecentralized system 210. In this example, 2500 medical devices areconnected to centralized system 210. The license logic may interact withcentralized system 210 and generate a notification that the number ofconnected medical devices is close to the limit. The notification can besent to a user of the centralized system and/or to the license server220 in order to notify the user and/or manufacturer that the license mayneed to be upgraded to accommodate additional medical devices.

The license can include information about an expiration of the license.For example, the license can contain an expiration date after which thelicense expires. To determine whether the license has expired, thecentralized system 210 can compare the date of the centralized system210 clock with the expiration date in the license. As the date from theclock approaches the expiration date, a warning may be generated thatthe license is about to expire. When the clock reaches the expirationdate, the centralized system 210 may disable the applications and/orfeatures or functions of the applications related to the license. Insome implementations, when the expiration date is a predefined number ofdays (or less) into the future, the centralized system may generate anotification message indicating the upcoming expiration date. Thenotification can be sent to a user of the centralized system 210 or tothe license server 220.

The license can contain information about the customer/licensee. Forexample, information about the company name, address, and approvedadministrators may be included in the license. In some implementations,this information can be used by the centralized system 210 and licenseserver 220 to verify the authenticity of the license, and to assist inverifying that the license has not been unscrupulously duplicated bysomeone that does not own the license

The license can be encrypted so that the license can only be read by adevice with the proper encryption/decryption algorithm andencryption/decryption parameters. For example, once theencryption/decryption parameter has been provided to the centralizedsystem 210, the centralized system 210 is able to decrypt the licensefrom license server 220. From the decrypted license, the centralizedsystem 210 determines which applications and features of theapplications are permitted to be used by the customer/licensee.Encryption/decryption of the license may include encryption/decryptiontechniques such as Advanced Encryption Standard (AES) or othertechniques. Stated differently, in the context of the enabled featuresof an application or device being changed by a license, theencryption/decryption technique described herein can be implemented in amanner in which only the systems and devices that the license wasintended for, will the license change or enable the functionality. Inthe event that a license is corrupted, invalid, or irrelevant for aspecific application or device, the encryption/decryption technique willensure that no changes to the functionality will be implemented and theoperator applying the license will be notified through the communicationpaths shown in FIG. 2.

The license may be generated by license server 220. The license server220 may be located at a manufacturer's facility. Centralized system 210may have access to the license server through connections 205 andnetwork 105. Network 105 may include a connection through the internetand/or one or more routers not shown in FIG. 2. For example, acustomer/licensee may purchase a license for an application. Themanufacturer can generate the license for the customer/licensee. Thelicense may be sent to the customer/licensee from the license server220, through connections 205, network 105 and the internet, to thecustomer's/licensee's centralized system 210. The license is thenutilized as described above. Alternatively, the license generated bylicense server 220 may be sent to centralized system 210 as anattachment to an email, a short message service message, or other meansfor delivering the license to centralized system 210.

A user interface (e.g., a graphical user interface, etc.) to access acentralized system can facilitate sending commands and receivinginformation from a device connected to the centralized system 210.Before sending commands or accessing information, authentication of theuser at the user interface may be required. The user may be required toprovide authentication information at the user interface and may berequired to provide additional authentication information to thecentralized system 210. Upon successful authentication, the user cansend commands to centralized system 210 and/or to medical devices 140connected to the centralized system and/or receive information form themedical devices 140 and/or centralized system 210.

The authentication credentials of a user can limit the types of commandsthat a user is permitted to send, the types of information the user ispermitted to receive, and/or or the medical devices that the user mayaccess. For example, a particular user may be permitted to receive onlymaintenance information from the medical devices 140 on centralizedsystem 210 and no other information, and may not be permitted to sendcommands to medical devices 140. In this example, a user limited tomaintenance data may be appropriate for maintenance personnel at ahospital. Other examples include the physician for a patient who may beauthorized to adjust a dosage level at a medical device wheremaintenance personnel would not be authorized to adjust dosages. Otherlimitations or sets of limitations are also possible.

Although the foregoing descriptions and processes were explained in thecontext of applications and licenses at a centralized system 210, thedescriptions and process also apply to medical devices 140.

FIG. 3 is a process diagram 300 illustrating a license that determineswhether an application is made available, and if it is made available,the features of the application that are made available. At 310 anapplication requiring a license to operate is started at centralizedsystem 210. At 320, the license is read by decrypting the contents ofthe license at the device where the application will operate. At 330,the contents of the license determine if use of the application ispermitted, and if permitted, the features of the application that arepermitted. At 340, when the license permits use of the application, theapplication and the features enabled by the license are made availableto a user, centralized system, or medical device.

At 310 an application requiring a license to operate is started atcentralized system 210. For example, an application for monitoring andcontrolling infusion pumps (e.g. infusion viewer) may be started atcentralized system 210. As part of starting the application,configuration information from the centralized system 210 may be read.For example, the configuration information may include number of medicaldevices connected to the centralized system 210.

At 320, the license is read by decrypting the contents of the license atthe device where the application will operate. For example, if thelicense server 220 that generated the license used the advancedencryption standard (AES) with a predetermined set of encryptionparameters, then the license may be decrypted using AES decryption andthe same encryption parameters to reveal the contents of the license.The contents of the license can determine the applications and featuresavailable at the device. The AES algorithm as used herein may be basedon permutations and substitutions. Permutations are rearrangements ofdata, and substitutions replace a unit of data with another. AES mayperform permutations and substitutions using different techniques. AESencryption and decryption algorithms may use a key schedule generatedfrom a seed key array of bytes. An implementation that generatesmultiple keys from an initial key instead of a single key greatlyincreases security. Other encryption techniques are also possible.

At 330, the contents of the license determine if use of the applicationis permitted, and if permitted, the features of the application that arepermitted. The contents of a license may permit use of one applicationor multiple applications. For each permitted application, the licensemay permit use of one or more features of the application. For example,the license may permit two applications with one feature of the firstapplication being permitted and three features of the second applicationbeing permitted.

The license may also contain logic that includes configurationinformation from centralized system 210 or computing landscape 100 todetermine if the customer/licensee is close to exceeding a licensedfeature. For example, the contents of the license may reveal that anapplication is licensed for use with a limited number of medicaldevices. For example, the maximum number of medical devices 140connected to centralized system 210 may be limited to 3000. In thisexample, the number of medical devices connected to centralized systemmay be determined to be 2999 from the configuration information atcentralized system 210. The logic in the license may determine that thenumber of devices connected to the centralized system 210 is within thepermitted maximum and thus permit use of the application. The logic maycause the generation of a notification that the number of medicaldevices is close to the permitted maximum. The notification may be sentto a user of the centralized system 210 and/or may be sent to thelicense server 220. The notification sent to the license server 220 canbe used by the manufacturer to sell an upgraded license to ensure thatthe license permits a sufficient number of medical devices to meet thecustomer's/licensee's needs.

At 340, if the license permits use of the application, the applicationand the features enabled by the license are made available to a user,centralized system 210, or medical device 140. Continuing the aboveexample, with 2999 medical devices connected to centralized system 210,the license determines that the application is permitted to operate. Insome implementations or applications, if the number of medical devices140 connected to centralized system were not 2999 but instead 3100, theapplication may be disabled or a feature of the application may bedisabled because the number of connected medical devices exceeds themaximum. In other implementations or applications, exceeding a licensedfeature may not cause an application or feature to be disabled butinstead may result in additional notifications or other responses.

The license features such as the above-noted number of medical devicesthat are permitted to be connected to centralized system 210 do notnecessarily constitute hard limits. In some implementations, theapplication and its features may not be disabled but instead morefrequent notifications may be sent to the user. For example,notifications may be generated at various intervals such as every timethe application is started, or every day, or every ten minutes. Thenotifications may require a response by a user of centralized system 210such that the inconvenience of the notifications and responses providessufficient motivation to the customer to purchase an appropriatelicense. A notification may also be sent to the manufacturer throughconnections 205, network 105, and the internet to license server 220.The notifications can allow the manufacturer to collect license fees forthe actual usage of the customer/licensee.

Although foregoing description of a process by which a license thatdetermines whether an application is made available at a centralizedsystem 210, and if it is made available, the features of the applicationthat are made available, the process also applies to licenses andapplications at a medical devices 140.

FIG. 4 is a process diagram illustrating inheriting a license at aselected application from another license for another application. At410, a selected application requiring a license to operate is started ata centralized system 210. The selected application is capable of beingoperated with a stand-alone license, if available. At 420, thecentralized system 210 determines that a stand-alone license is notavailable for the selected application. At 430, the centralized system210 determines whether an applicable license for the selectedapplication is available from another license at the centralized system210. At 440, an applicable license is inherited at the selectedapplication from the other license. At 450, the centralized system 210determines from the inherited license which features of the selectedapplication to enable. At 460, the centralized system 210 makesavailable to the user, centralized system 210, and/or medical device 140the enabled features of the selected application.

At 410, a selected application requiring a license to operate is startedat a centralized system 210. The selected application is capable ofbeing operated with a stand-alone license, if available. A stand-alonelicense is a license to operate just the selected application. Forexample, a customer/licensee may purchase a stand-alone license formonitoring and controlling infusion pumps such as an infusion viewerapplication. The stand-alone license allows the customer/licensee tooperate just the infusion viewer application. The stand-alone licensethat permits use of the infusion viewer application does not itselfpermit use of other applications. In contrast, a license that is notstand-alone may license the use of multiple applications. Someapplications can be licensed with either a stand-alone license or alicense that is not stand-alone. In some implementations, theapplication may be one of a closely related family of executableprograms. For example, a family of applications may correspond toapplications associated with a particular product line such as aparticular infusion pump product line.

At 420, the centralized system 210 determines that a stand-alone licenseis not available for the selected application. For example, an infusionviewer application may be started on the centralized system 210. Theinfusion viewer application requires a license to operate. Uponstart-up, the infusion viewer application may search for a stand-alonelicense. The result of the search may be that no stand-alone license isfound for the infusion viewer application, or the result may be that astand-alone license is found but is not valid, or the result may be thata stand-alone license is found but a user or application has selectedthat a stand-alone license not be used. Examples of reasons why astand-alone license may be invalid include the license may have anexpiration date that has passed, or the stand-alone license may be validfor one family of medical devices (e.g. one infusion pump productfamily) but a different family of medical devices is connected to thecentralized system 210.

At 430, the centralized system determines whether an applicable licensefor the selected application is available from another license foranother application at the centralized system 210. The centralizedsystem may search for licenses under which the selected application canbe operated. When one application can use a license or a portion of alicense associated with another application, the license is said to beinherited. For example, upon the start of an infusion viewerapplication, and with no stand-alone license found, the centralizedsystem may search for a license for another application whose licenseincludes a license for the infusion viewer application. In this example,the license for the other application also includes a license for theinfusion viewer application and may include licenses for additionalapplications as well. In some cases, more than one applicable licensefor the selected application may be found at the centralized system.When more than one applicable license could be used, logic at thecentralized system or a user will select which license to use to operatethe selected application. Different licenses may have differentapplication features enabled. For example, one license may allow 2500medical devices to be connected to an infusion viewer application, andanother applicable license may allow 5000 medical devices. Depending onthe license selected by the logic at the centralized system or selectedby the user, the number of permitted medical devices connected to thecentralized system may have different values. This may affect the numberof allowable devices before a notification is generated that the systemis close to the maximum allowable by the selected license.

At 440, an applicable license is inherited at the selected applicationfrom the other application. If more than one applicable license isavailable, the user or centralized system 210 selects which of theapplicable licenses to inherit in order to operate the selectedapplication.

At 450, the centralized system determines from the inherited licensewhich features of the selected application to enable. The inheritedlicense can enable features of the selected application. Logic may beincluded in the inherited license that interacts with configurationinformation from centralized system 210 and/or medical devices 140. Forexample, if the number of medical devices 140 is close to the maximum, anotification may be generated as described above.

At 460, the centralized system 210 makes available to the user orcentralized system the enabled features of the selected application.Based on the inherited license, the selected application provides theenabled features subject to any logic contained in the inheritedlicense.

Although the foregoing description of license inheritance is directedtoward a selected application at a centralized system 210 inheriting anapplicable license from another application at a centralized system 210,the applicable license can also be inherited from an application atmedical device 140 to centralized system 210, or from an application atone medical device 140 to an application on another medical device 140,or from an application on a medical device 140 to an application at acentralized system 210.

FIG. 5 is a process diagram illustrating a license server 220 updating alicense. At 510, a selected application requiring a license to operateis started at a centralized system 210, the license being available as astand-alone license, or as an inherited license. At 520, the centralizedsystem 210 determines whether communication with a license server 220 isrequired. At 530, the centralized system 210 initiates communicationwith the license server 220. At 540, license information is sent fromthe centralized system 210 to the license server 220. At 550, thecentralized system 210 receives license update information from thelicense server 220. At 560, the license at the centralized system 210 isupdated.

At 510, a selected application requiring a license to operate is startedat a centralized system 210. A license may be available as a stand-alonelicense or as an inherited license. If no license is available, in someimplementations the selected application may still be started butwithout the features that require a license to be enabled. In otherimplementations, starting the application may result in little or noneof the functionality that the selected application provides with alicense. In this case, starting the application may result in simplychecking for a license.

At 520, the centralized system determines whether communication with alicense server 220 is required. An indication that communication with alicense server 220 is required may be determined from the license, orthe indication may be determined from the selected application, or theindication may be determined from logic in the license that interactswith the selected application. For example, the selected application maybe an infusion viewer application. Upon starting the application, aninherited license may be selected. In this example the inherited licensepermits a maximum of 3000 medical devices 140 connected to thecentralized system 210, and the centralized system 210 has 2550 medicaldevices connected to it. In this example, logic in the license maydetermine that when the maximum is reached with fewer than 500additional medical devices 140, the license server 220 may be contactedto alert the manufacturer that the infusion viewer license is close tothe maximum number of permitted medical devices 140. This benefits thecustomer/licensee by ensuring that the license meets the needs of thecustomer/licensee and it benefits the manufacturer by providinginformation that can be used to ensure that the manufacturer is paid forthe license that meets the customer's/licensee's needs. Another exampleof a feature of the license that may require communication with thelicense server is an expiration date of the license that is within apredetermined number of days of the current date. Other features mayalso require communication between the centralized system 210 andlicense server 220.

At 530, the centralized system 210 initiates communication with thelicense server. In some implementations, the license server 220 isconnected through connections 205 and through network 105 to centralizedsystem 210 and medical devices 140. In some implementations, thecommunication through network 105 may include communication through theInternet. The license server 220 may provide a web portal, short messageservice interface, or other means to communicate with centralized system210 and/or medical devices 140. For example, centralized system 210 maycommunicate with license server 220 through a web portal whereinformation can be exchanged including license information. Initiatingcommunication may include establishing a secure connection between thelicense server 220 and the centralized system 210 and/or medical devices140. The secure connection may include a transport layer security (TLS)connection, secure sockets security (SSL) connection, or other secureconnection.

At 540, the license information is sent from the centralized system 210to the license server 220. Once communication has been initiated and anyrequired security established between the license server 220 and thecentralized system 210, the centralized system 210 can pass the licenseinformation related to the selected application to the license server.Configuration information from the centralized system 210 can also besent. Continuing the previous example, with the selected applicationbeing an infusion viewer application, the license information passed tothe license server 220 includes information such as the maximum numberof medical devices permitted by the license. For example, theconfiguration information passed from the centralized system 210 tolicense server 220 may include the number of medical devices connectedto the centralized system 210. Other information related to the licensemay also be sent with the license to the license server 220. Also, otherconfiguration information of the centralized system 210 including thetype, and/or status of the medical devices 140 connected to thecentralized system 210 may be sent.

The license server 220 may also receive information related to thelicense form the manufacturer. For example, the customer/licensee mayhave purchased an updated stand-alone license or updated license fromwhich the selected application has inherited the license. For example,the customer/licensee may have purchased an upgraded license permitting5000 medical devices to be connected to the centralized system insteadof 3000 medical devices. The manufacturer may provide an updated licenseto license server 220 reflecting the upgraded license.

At 550, the centralized system 210 receives license update informationfrom the license server 220. Continuing the above example, the licenseserver 220 can send an updated license to the centralized system 210through the network 105. For example, the updated license may allow 5000medical devices instead of 3000. The updated license may also includenewly enabled features of the selected application. The updated licensemay also enable additional applications that were not previouslylicensed to the customer/licensee.

At 560, the license at the centralized system is updated. In someimplementations, the updated license is stored at the centralized system210. In other implementations, the license can be stored at data storage125. When the selected application is started, a determination is madewhether communication with the license server 220 is needed. If thecentralized system 210 determines that the license server 220 does notneed to be contacted, the centralized system 210 may operate theselected application according to the license and without communicationwith the license server 220. In some implementations, when thecentralized system 210 determines that the license server must becontacted and the license server is unavailable due to a connectionproblem through the network or internet, or other problem, the selectedapplication may continue to operate according to the previous licenseuntil communication with the license server is successful. In otherimplementations, if the license server 220 cannot be contacted, theselected application may be disabled until communication with licenseserver 220 is successful.

In other implementations, the license may not be stored at thecentralized system 210 or data storage 125. When the selectedapplication is started, the centralized system 210 must communicatewidth he license server 220 and the license must be sent from thelicense server before the application can be operated.

Although the foregoing description of the use of a license server 220 isdirected toward a centralized system 210 communicating with a licenseserver 220, a medical device 140 can also communicate with a licenseserver 220 in the same manner.

One or more aspects or features of the subject matter described hereinmay be realized in digital electronic circuitry, integrated circuitry,specially designed ASICs (application specific integrated circuits),computer hardware, firmware, software, and/or combinations thereof.These various implementations may include implementation in one or morecomputer programs that are executable and/or interpretable on aprogrammable system including at least one programmable processor, whichmay be special or general purpose, coupled to receive data andinstructions from, and to transmit data and instructions to, a storagesystem, at least one input device (e.g., mouse, touch screen, etc.), andat least one output device.

These computer programs, which can also be referred to programs,software, software applications, applications, components, or code,include machine instructions for a programmable processor, and can beimplemented in a high-level procedural language, an object-orientedprogramming language, a functional programming language, a logicalprogramming language, and/or in assembly/machine language. As usedherein, the term “machine-readable medium” refers to any computerprogram product, apparatus and/or device, such as for example magneticdiscs, optical disks, memory, and Programmable Logic Devices (PLDs),used to provide machine instructions and/or data to a programmableprocessor, including a machine-readable medium that receives machineinstructions as a machine-readable signal. The term “machine-readablesignal” refers to any signal used to provide machine instructions and/ordata to a programmable processor. The machine-readable medium can storesuch machine instructions non-transitorily, such as for example as woulda non-transient solid state memory or a magnetic hard drive or anyequivalent storage medium. The machine-readable medium can alternativelyor additionally store such machine instructions in a transient manner,such as for example as would a processor cache or other random accessmemory associated with one or more physical processor cores.

To provide for interaction with a user, the subject matter describedherein can be implemented on a computer having a display device, such asfor example a cathode ray tube (CRT) or a liquid crystal display (LCD)monitor for displaying information to the user and a keyboard and apointing device, such as for example a mouse or a trackball, by whichthe user may provide input to the computer. Other kinds of devices canbe used to provide for interaction with a user as well. For example,feedback provided to the user can be any form of sensory feedback, suchas for example visual feedback, auditory feedback, or tactile feedback;and input from the user may be received in any form, including, but notlimited to, acoustic, speech, or tactile input. Other possible inputdevices include, but are not limited to, touch screens or othertouch-sensitive devices such as single or multi-point resistive orcapacitive trackpads, voice recognition hardware and software, opticalscanners, optical pointers, digital image capture devices and associatedinterpretation software, and the like.

The subject matter described herein can be embodied in systems,apparatus, methods, and/or articles depending on the desiredconfiguration. The implementations set forth in the foregoingdescription do not represent all implementations consistent with thesubject matter described herein. Instead, they are merely some examplesconsistent with aspects related to the described subject matter.Although a few variations have been described in detail above, othermodifications or additions are possible. In particular, further featuresand/or variations can be provided in addition to those set forth herein.For example, the implementations described above can be directed tovarious combinations and subcombinations of the disclosed featuresand/or combinations and subcombinations of several further featuresdisclosed above. In addition, the logic flow(s) depicted in theaccompanying figures and/or described herein do not necessarily requirethe particular order shown, or sequential order, to achieve desirableresults. Other implementations may be within the scope of the followingclaims.

What is claimed is:
 1. A method comprising: receiving, at a centralizedsystem executing applications for monitoring and operating a pluralityof network enabled medical devices, an indication to start a selectedapplication at the centralized system, wherein the selected applicationrequires a license to operate and, at the time the indication isreceived, the selected application has a first license; determining, atthe centralized system, to inherit at least a portion of a secondlicense to operate the selected application at the centralized systeminstead of using the first license; inheriting at least the portion ofthe second license to form an inherited license; enabling features ofthe selected application according to the inherited license; andstarting, at the centralized system, the selected application with theenabled features.
 2. The method of claim 1, wherein the first license isa license to operate only the selected application.
 3. The method ofclaim 1, wherein at least one of the features enabled by the inheritedlicense is different from features enabled by the first license.
 4. Themethod of claim 1, wherein the selected application is a command andstatus application for an infusion pump.
 5. The method of claim 1,wherein the determining comprises selecting to use the portion of thesecond license rather than the first license.
 6. The method of claim 1,wherein the determining comprises determining that the first license isnot available or the first license is not valid.
 7. The method of claim1, wherein the determining comprises: reading the portion of the secondlicense from the centralized system and extracting license informationapplicable to the selected application; determining that the portion ofthe second license permits use of the selected application
 8. The methodof claim 1, wherein the medical device comprises one of an infusionpump, a vital signs monitor, and a ventilator.
 9. The method of claim 1,wherein the selected application comprises executable instructions forthe centralized system.
 10. A method comprising: receiving, at a firstnetwork enabled medical device, an indication to start a selectedapplication at the medical device, wherein the selected applicationrequires a license to operate and, at the time the indication isreceived, the selected application has a first license; determining, atthe first network enabled medical device, to inherit from a centralizedsystem at least a portion of a second license to operate the selectedapplication at the first network enabled medical device instead of usingthe first license, wherein the centralized system monitors and operatesa plurality of network enabled medical devices including the firstmedical device; inheriting at least the portion of the second license toform an inherited license; enabling features of the selected applicationaccording to the inherited license; and starting, at the first networkenabled medical device, the selected application with the enabledfeatures.
 11. The method of claim 10, wherein the first license is alicense to operate only the selected application.
 12. The method ofclaim 10, wherein at least one of the features enabled by the inheritedlicense is different from features enabled by the first license.
 13. Themethod of claim 10, wherein the selected application is a command andstatus application for an infusion pump.
 14. The method of claim 10,wherein the determining comprises selecting to use the portion of thesecond license rather than the first license.
 15. The method of claim10, wherein the determining comprises determining that the first licenseis not available or the first license is not valid.
 16. The method ofclaim 10, wherein the determining comprises: reading the portion of thesecond license from the centralized system and extracting licenseinformation applicable to the selected application; determining that theportion of the second license permits use of the selected application17. The method of claim 10, wherein the first medical device comprisesone of an infusion pump, a vital signs monitor, and a ventilator. 18.The method of claim 10, wherein the selected application comprisesexecutable instructions for the first medical device.
 19. A methodcomprising: receiving, at a centralized system executing applicationsfor monitoring and operating a plurality of network enabled medicaldevices, an indication to start one of the applications at thecentralized system, wherein the application requires a decrypted licenseto operate; decrypting a license to produce the decrypted license;determining from the decrypted license that communication with a licenseserver is required; polling the license server with data characterizingthe decrypted license to receive a new license; and updating thedecrypted license based on the new license.
 20. The method of claim 1,wherein the application is a command and status application for aninfusion pump.
 21. The method of claim 1, wherein the decryptingcomprises decryption with an advanced encryption standard.
 22. Themethod of claim 1, wherein the determining from the decrypted licensethat communication with a license server is required comprises:searching the decrypted license for a limit value to a configurationparameter of the centralized system; searching a configuration of thecentralized system for an actual value of the configuration parameter;and determining from the limit value and the actual value whethercommunication with the license server must be initiated.
 23. The methodof claim 1, wherein the determining from the decrypted license thatcommunication with a license server is required comprises determiningfrom logic included in the decrypted license that communication with thelicense server is required.
 24. The method of claim 1, wherein theplurality of network enabled medical devices comprises one or more ofinfusion pumps, vital signs monitors, and ventilators.
 25. The method ofclaim 1, wherein the application comprises executable instructions forthe centralized system.